Lymph node metastasis in multiple synchronous early gastric cancer
Lymph node metastasis in multiple synchronous early gastric cancer
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DOI：
10.1016/j.gie.2011.04.009
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发表时间：
2011-08-01
影响因子：
7.7
通讯作者：
Song, In Sung
中科院分区：
文献类型：
--
作者：
Choi, Jeongmin;Kim, Sang Gyun;Song, In Sung
背景资料：虽然内镜下切除早期胃癌（EGC）越来越多，它还没有确定是否内镜下切除的适应症是同样可接受的多EGC.Objective：比较各种临床病理因素和淋巴结（LN）转移的风险之间的多个和孤立EGC.Design：病例对照研究。本研究涉及1717例患者，其中156例为多发性EGCs，1561例为孤立性EGCs.干预：胃切除术联合LN剥离.主要结果测量：LN转移的发生率.结果：在多发性EGCs中，主病灶比副病灶具有更大的肿瘤大小和更深的浸润深度（P <0.001）。在肿瘤大小、浸润深度、淋巴管浸润和LN转移发生率方面，多发性EGCs的临床病理特征与孤立性EGCs相似。重要的是，符合内镜下切除指征标准的多个EGCs的LN转移风险与单个EGCs无显著差异。符合常规内镜手术指征的肿瘤没有LN转移的风险，而符合扩大适应症的肿瘤在两组中显示出相似的LN转移风险。结论：多发性EGCs与孤立性EGCs具有相似的临床病理特征和淋巴结转移危险性。对于符合内镜下切除指征的多种EGC，内镜下切除可作为治愈性治疗。需要进一步的研究来验证本研究结果。（Gastrointest Endosc 2011;74：276-84.）
Background: Although endoscopic resection for early gastric cancer (EGC) is increasingly available, it has not been determined whether indications for endoscopic resection are equally acceptable for multiple EGCs.Objective: To compare the various clinicopathologic factors and risk of lymph node (LN) metastasis between multiple and solitary EGCs.Design: Case-control study.Setting: University hospital.Patients: This study involved 1717 patients with 156 multiple and 1561 solitary EGCs.Intervention: Gastrectomy with LN dissection.Main Outcome Measurements: Incidence of LN metastasis.Results: In multiple EGCs, main lesions had larger tumor size and deeper invasion depth than the accessory lesions (P < .001). The clinicopathologic features of multiple EGCs were similar to those of solitary EGCs with respect to tumor size, depth of invasion, lymphovascular invasion, and incidence of LN metastasis. Importantly, the risk of LN metastasis in multiple EGCs that met the indication criteria for endoscopic resection was not significantly different from that in solitary EGCs. Tumors meeting conventional indications for endoscopic resection had no risk of LN metastasis, whereas tumors meeting expanded indications showed a similar risk of LN metastasis in the two groups. In multiple EGCs, tumor size >= 3 cm and lymphovascular invasion were independent risk factors of LN metastasis.Limitations: Small number of patients with multiple EGCs studied.Conclusion: Multiple EGCs had clinicopathologic characteristics and risk of LN metastasis similar to those of solitary EGCs. Endoscopic resection may be adopted as curative treatment for multiple EGCs that meet indications for endoscopic resection. Further studies are needed to verify the present study results. (Gastrointest Endosc 2011;74:276-84.)